HomeMy WebLinkAboutCORINA LT 1
Corina
Lot 1
#051-232-87
Municipality of Anchorage
On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP221069 PID Number: 051-232-17
Dwelling: ❑N Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑■ New ❑ Upgrade
Name
HULTQUIST HOMES INC
ABSORPTION FIELD
❑ Deep Trench A Wide Trench ❑ Bed ❑ Mound
Site Address
19038 RICHNER RD, Chugiak
❑ Other
Phone
(907) 310-2501
Number of Bedrooms
3
Soil Rating
Total depth from original grade
1.2 GPD/SF
10.0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
7.0 Ft.
Gravel depth beneath pipe
3.0 Ft.
Subdivision Block Lot
*180
Fill added above original grade
0.2 Ft.
Gravel length
46 Ft.
Township Range Section
15N 1W 18
Gravel width
5.0 Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION
DISTANCES
To
Septic
Tank
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Field
Tank
Line
388 Ft2
11
Ft.
Well
>100'
>1 00'
N/A
N/A
>25'
TANK 9Septic ElS.T.E.P. El Holding El Other
Manufacturer
Greer
Capacity
1000 Gal.
Surface Water
> 100'
>1 00'
N/A
N/A
Material
Plastic
Number of compartments
2
Lot Line
>5'
>10'
N/A
N/A
NA
Foundation
>10'
> 1 0'
N/A
N/A
LIFT STATION
turer
Capacity
Remarks Proposed Corina Sub, Lot 1
Gal.
Alarm location
installed by
Installer
PIPE MATERIAL House to tank D3034 Tankto
D3034
Littler Dipper Excavating
Drainfield D3034 CO/MTD3034
Inspector J. Millette
BENCH MARK (Assumed elevation) 100 ft
Inspection4/7/22 4/8/22
Location and description
dates:2nd
aro 4/8/22
Bottom of siding
4'h
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
�qlt
Conditional Approval: Date
'oF
�,;� .. , cp,F� i
TH
Septic System I
r� BenjaminSchiller /
��1�'slF�• C
y
Approved Date 4/ ! 20 t Z
/2//222 •������®s
F�pROFESSIONP1
11��.`
Note: this approval does not include well permit requirements.
��\�®��
trcev voiuzri a/
PROFILE AS-BUILT
(NO SCALE)
94.0
89.7
94.6
100.5FCOMH SV1000 GAL
SEPTIC TANK
100.8 FINISH GRADE
46'
DRAINFIELD ROCK
TH#1NO GROUNDWATER 2/2/2022
90.6
93.6 COCO84.1
93.6
100.6 ORIGINAL GRADE MT2CO93.8
Benjamin Schiller
CE 12592
R
E
GISTEREDPROFES S I O N A LENGINEERNov 03, 2022
PERMIT # OSP221069 PID # 051-232-17
T15N R1W SEC 18 LOT 180
Benjamin Schiller
CE 12592R
E
GISTEREDPROFES S I O N A LENGINEER1"=50'
1000-GAL
SEPTIC
TANK w/ 20"
MANWAY
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
FD - FLOW DIVERTER
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
PERMIT # OSP221069 PID # 051-232-17
T15N R1W SEC 18 LOT 180
A B
FCO 54.4
MH 54.0
SV 55.1
A
B
2CO 55.7
CO1 57.4
CO2 78.4
9.8
27.7
32.3
34.8
40.2
86.1FEET
0 50 100
NOTE:
RICHNER ROAD
3/9/2023 BIRCHWOOD LOOP
170
33' PATENT R.O.W.
& UTILITY RESERVE
170
EXISTING WELL w/
100' RADIUS
TH#2
TH#1
3-BDRM HOM
E
160150 NEW WELL
46' LONG x 5' WIDE, 3' EFFECTIVE
DEPTH ABSORPTION TRENCH
CO2 MT
CO1
2CO
FCO
SEPTIC AREAS FOR LOTS 168A & 168B ARE >100'
FROM THE PROPOSED WELL LOCATION
NEIGHBORING
SEPTIC AREA
PERMITTED
SEPTIC FOR
PROPOSED
LOT 2
EXISTING WEL
EXISTING 100'
WELL RADII
PROFILE AS-BUILT
MT 79.785.8
Mark Begich
Mayor
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue:
Parcel Identification Number:
Legal Description Property Owner Name & Address:
Pump Installation Date:
Pump Intake Depth Below Top of Well Casing: feet
Pump Manufacturer’s Name:
Pump Model:
Pump Size hp
Pitless Adapter Burial Depth: feet
Pitless Adapter Manufacturer’s Name:
Pitless Adapter Installer:
Well Disinfected Upon Completion? Yes No
Method of Disinfection:
Comments:
Pump Installer Name:
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
Whaa ®n 1,AJater V,,Va�Do Dnc.
1190 N. Wasilla-Fish hook Road
Wasilla, AK 99654
(907)376-2041
Name:
Hultquist Homes
Address:
19507 Richner Rd
City:
Chugiak State: Al( Zip Code: 99567
Well Site:
T15NR1 W Sec 18
Lot/Block: L180 A
Additional:
19038 Richner Rd, Chugiak, AK
Well Depth:
70 ft.
From:
20: Formation:
stickup
Below Ground:
68 ft.
2
3 topsoil/organics
Above Ground:
2 ft.
3
8 gravel/dirt/sand
Gal/Min:
7
8
23 sand/damp
23
36 brown silt/clay
Static Level:
38 ft.
36
67 grey silt/clay
67
69 gravel/water/sand
Casing:
69ft. of 6 in. x .25 in. steel
69
70 bedrock
Liner Pipe:
N/A
Screened:
N/A
Perforated:
N/A
WATER QUALITY TESTING
Co iform A,�- 6r4 --n",; Col/100rnL
Grouted:
Yes, 2 bags
Mtrates Acro��r�a mg/L
Depth:
Arssar►ic n.or o-ti�r,g/L
Develop. Method:
Air
Use of Well:
Residential
Drilling Method:
Rotary
Misc:
Other:
develop with pump
The well was pumped 5' off the bottom with 100% draw down for 2 hours and recovered at 7gpm .
Date Drilled:
5/2/2022 Driller: Seth Moore
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MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Water & Wastewater System Permit
Permit Number: OSP221069
Work Type: WellSeptic Initial
Tax Code Number: 05123217000
Site Legal Address: T15N R1 W SEC 18 LT 180 G:1054
Site Mailing Address: 19038 RICHNER RD, Chugiak
Owner: HULTQUIST HOMES INC
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date
Lot Size in Sq Ft:
Total Bedrooms:
AAA t
1
Departinent
4/6/2022
4/6/2023
1:•11
Q Disposal Field 0 Septic Tank Holding Tank Privy Q Private Well Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By:
Issued By:
Date:
Date: Z
3
�l�I UMCPA U7 Y OF" HCH0Rr\ GE
UD
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 051-232-17
Property owner(s) Kourosh Partow Day phone (907) 310-2501
Mailing address 12570 Old Seward Hwy Suite 204 Anchorage, Alaska 99515
Site address 19036 Richner Rd
Legal description (Sub'd., Block & Lot) Lot 180 (Proposed Lot 1)
Legal description (Township, Range & Section) T1 5N R1 W SEC 18
Lot Size 108,900 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(N all that apply)
Absorption Field
❑X
InitialSingle
Family (SF)
1K
(w/wo ADU)
Septic Tank
❑X
Upgrade A
Duplex (D)
❑
Holding Tank
❑
Renewal ❑
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: g 7 O Waiver Fees:
Date of Payment: Y�S�2 Z Date of Payment:
Receipt Number: 01-75'3D Receipt Number:
Permit No. 2-2 106 !3 Waiver No.
Permit App_::- : :-'.,'c
April 6, 2022
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: T15N R1W Section 18 Lot 180 – Richner Road 4/6/22
Well and septic system design (Proposed Lot 1)
Dear On-Site Services Engineer:
The owner of the above lot intends to build a 3-bedroom home on the property, so we are
submitting this permit application for the construction of a new well and septic system. The
attached site plan identifies the location of the home as well as the proposed well and septic site.
No conflicts exist between this proposed system and any other well or septic system, whether on
this lot or adjacent lots. The owner is in the process of subdividing the property into two individual
lots. The existing well and septic on proposed Lot 2 will be preserved for its future development.
The attached site plan identifies the proposed lots as well as the lot line that will divide them.
The ground surface on the lot is mostly flat. There are no slopes greater than 25% within 50 feet
downslope of proposed septic location. Elevations are shown on the site plan showing the grade
and direction of flow. The new trench will be constructed parallel to the slope as much as possible.
A small portion of upper part of the effective area will be in the GP strata. A sieve analysis was
performed on the underlying sand layer, which showed SP/SM sands. This lower layer will offer
sufficient treatment to the effluent that passes through it without the need of a sand liner. Due to
the fast percolation rate of the GP layer, any effluent flowing through the sidewalls would travel
vertically down into the sand layer where it will be treated sufficiently. We expect no adverse
effects on groundwater, aquifers, or neighboring wells from the use of the GP layer for absorption
area.
Wells on this and adjacent lots are shown. The new system will be a minimum of 100’ from all
wells and surface water, and more than 5’ away from the septic tank. The alternate site is located
more than 6’ away.
Please refer to the attached test hole logs, soils analysis, plan and profile pages for the septic design.
If this design is followed, there will be no adverse impacts to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221069, Deb Wockenfuss, 04/06/22
ALTERNATE SITE
Benjamin Schiller
CE 12592R
EGISTEREDPROFE S S I O N ALENGINEER
1"=50'
1000-GAL
SEPTIC
TANK w/ 20"
MANWAY
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FS - FLOW SPLITTER VALVE
FD - FLOW DIVERTER
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
T15N R1W SEC 18 LOT 180
FEET
0 50 100
NOTE:
NO SLOPES >46% OR SURFACE WATER WITHIN 100' OF THE
PROPOSED SEPTIC SYSTEM
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS
PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC
SYSTEMS.
RICHNER ROAD
4/1/2022 BIRCHWOO
D LOOP
170
33' PATENT R.O.W.
& UTILITY RESERVE
170
EXISTING WELL w/
100' RADIUS
TH#2
TH#1
3-BDRM HOME
16 0150 PROPOSED
WELL w/ 100'
RADIUS
45' LONG x 5' WIDE, 3' EFFECTIVE
DEPTH ABSORPTION TRENCH
CO
MT
MT
CO
2CO
FCO
SEPTIC AREAS FOR LOTS 168A & 168B ARE >100'
FROM THE PROPOSED WELL LOCATION
NEIGHBORING
SEPTIC AREA
PERMITTED
SEPTIC FOR
PROPOSED
LOT 2
EXISTING WELL ON L180 TO
REMAIN IN SERVICE FOR
FUTURE DEVELOPMENT OF
PROPOSED LOT 2. IF
SUBDIVISION FALLS
THROUGH, WELL MUST BE
DECOMMISSIONED OR
CONNECTED TO NEW HOME.
EXISTING 100'
WELL RADII
≥10'
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221069, Deb Wockenfuss, 04/06/22
T15N R1W SEC18 LOT 180
TYPICAL TRENCH SECTION
(NO SCALE)
NOTES:
1. GRADE AREA OVER TRENCH TO DRAIN AWAY
2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2'
WITH 2" OF INSULATION
3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER
THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY
Benjamin Schiller
CE 12592R
EGISTEREDPROFE S S I O N ALENGINEERDESIGN FACTORS:SYSTEM REQUIREMENTS:
450 GPD PEAK FLOW
PERK RATE: <1 MIN/IN
APPLICATION RATE: 1.2 GPD/SF
SHALLOW 5 WIDE TRENCH SYSTEM
1000-GAL SEPTIC TANK w/ 20" MANWAY
BOTTOM OF TRENCH: 7' 6" BELOW HIGHEST GRADE
FLOW LINE ELEVATION: 4' 6" BELOW HIGHEST GRADE
TOP OF TRENCH: 6" ABOVE GRADE
450 GPD / 1.2 GPD/SF / 5' WIDE * 0.58 RED FACTOR (3' EFF DEPTH) = 43.8 LF TRENCH REQUIRED
(45 LF SPECIFIED)
4/1/2022
4" PERFORATED PVC
(HOLES DOWN)
DRAINFIELD ROCK
5'
6"
4'
3'
GEOTEXTILE FABRIC
6"
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221069, Deb Wockenfuss, 04/06/22
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE: PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
DEPTH
(feet)
TEST HOLE 1
DATE READING START TIME NET TIME
(minutes)
DEPTH to
WATER NET DROP
(inches)(inches)
DATE OF MONITORING
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING
IF YES @ WHAT DEPTH?
2/10/22 1
2
3
4
5
6
Professional Engineers Stamp:
NO
T15N R1W SEC8 L180 (Proposed L1)
2/10/22 051-232-17
Hultquist Homes
11:461
2
3
4
5
6
0
11:49
11:51
11:52
11:53
11:56
0.5' OB
0:28
Benjamin Schiller
CE 12592R
EGISTEREDPROFE S S I O N ALENGINEER2/10/22
PERC TEST LOCATION
TECHNICIAN: L.TIDWELL
6 6
N/A
DRY
2/22/22
COMMENTS:
0 0:33 6 6
0 0:32 6 6
0 0:38 6 6
0 0:34 6 6
0 0:36 6 6
SANDY GRAVEL w/ COBBLES
(GP)
CLEAN SAND
(SP-SM)
USCS CLASSIFICATION IS VISUALLY DETERMINED UNLESS NOTED OTHERWISE
SANDY GRAVEL w/ COBBLES (GP) STRATA PERCOLATION RATE <1 MPI
PERCOLATION RATE: (MIN/INCH)0.10
6" DIAMETER TEST HOLE
SITE PLAN
PRESOAKED PRIOR TO TESTING? NO
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221069, Deb Wockenfuss, 04/06/22
LEGAL DESCRIPTION:
PERFORMED FOR:
DATE: PARCEL ID#:
SOILS LOG AND PERCOLATION TEST
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
DEPTH
(feet)
TEST HOLE 2
DATE READING START TIME NET TIME
(minutes)
DEPTH to
WATER NET DROP
PERCOLATION RATE: (MIN/INCH)
(inches)(inches)
DATE OF MONITORING
WAS GROUND WATER ENCOUNTERED?
DEPTH TO WATER AFTER MONITORING
IF YES @ WHAT DEPTH?
0.07
2/10/22 1
2
3
4
5
6
SANDY GRAVEL w/ COBBLES
(GP)
Professional Engineers Stamp:
NO
T15N R1W SEC8 L180 (Proposed L1)
2/10/22 051-232-17
Hultquist Homes
12:331
2
3
4
5
6
0
12:35
12:36
12:37
12:38
12:39
0.5' OB
0:20
Benjamin Schiller
CE 12592R
EGISTEREDPROFE S S I O N ALENGINEER2/10/22
PERC TEST LOCATION
TECHNICIAN: L.TIDWELL
6 6
N/A
DRY
2/22/22
COMMENTS:
6" DIAMETER TEST HOLE
SITE PLAN
0 0:27 6 6
0 0:28 6 6
0 0:31 6 6
0 0:30 6 6
0 0:28 6 6
CLEAN SAND
(SP/SM PER SEIVE ANALYSIS)
USCS CLASSIFICATION IS VISUALLY DETERMINED UNLESS NOTED OTHERWISE
SANDY GRAVEL w/ COBBLES (GP) STRATA PERCOLATION RATE <1 MPI
PRESOAKED PRIOR TO TESTING? NO
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221069, Deb Wockenfuss, 04/06/22
% GRAVEL 12.9 USCS SP-SM
% SAND 76.2 USACOE FC NFS
% SILT/CLAY 10.9 % PASS. 0.02 mm 1.0
% MOIST. CONTENT 6.3 % PASS. 0.002 mm N/A
N/A
N/A
N/A
SIEVE SIEVE TOTAL % SPECIFICATION
SIZE (mm) SIZE (U.S.) PASSING (% PASSING)
152.40 6"
76.20 3"
38.10 1.5"100
19.00 3/4"97
12.70 1/2"94
9.50 3/8"93
4.75 #4 87
2.00 #10 84
0.85 #20 81
0.43 #40 78
0.25 #60 66
0.15 #100 39
0.075 #200 10.9
ELAPSED DIAMETER
TIME (MIN)(mm)
0
1 0.0524
2 0.0375
5 0.0239
8 0.0189
15 0.0139
30
60
250
1440
SOUNDNESS OF AGG.
(ASTM C88)
DEGRADATION
(ATM T-313)
LA ABRASION
(ASTM C131/C535)
SP. GRAV. COARSE AGG.
(ASTM C127)
CLASSIFICATION:
DATE RECEIVED:
TESTED BY:
REVIEWED BY:
UNIFORMITY COEFFICIENT (Cu)
COEFFICIENT OF GRADATION (Cc)
ASTM D1557 (uncorrected)
ASTM D4718 (corrected)
OPTIMUM MOIST. CONTENT. (corrected)
PROJECT CLIENT:
PROJECT NAME:
PROJECT NO.:
SAMPLE DESC.:
NGE-TFT ID #:3.1
1.0
Forge Engineering, Inc.
HYDROMETER RESULT
N/A
SIEVE ANALYSIS RESULT
2022 Materials Testing
6309-22
T15 R1WSE C18 L180 TH-2(L1)
22-S-1
Poorly-graded sand w/ silt
3/30/2022
Erik Boatwright
Andrew Fortt
TOTAL %
PASSING
0.9
0.2
11301 Olive Lane ∙ Anchorage, Alaska 99515 ∙ Phone: 907-344-5934 ∙ Fax: 907-344-5993 ∙ www.nge-tft.com
N/A
N/A
The testing services reported herein have been performed to recognized industry standards, unless otherwise noted. No other warranty is made. Should engineering
interpretation or opinion be required, NGE-TFT will provide upon written request.
N/A
3.7
2.3
1.6
115
120
125
130
135
140
145
0 2 4 6 8 10 12 14 16DRY DENSITY (pcf)MOISTURE CONTENT (%)
MOISTURE-DENSITY RELATIONSHIP ASTM D1557
SILT or CLAYCOBBLES
GRAVEL
Coarse Fine
SAND
Coarse Medium Fine
0
10
20
30
40
50
60
70
80
90
100
0.0010.01 0.11 10 100 FINER BY MASS (%)GRAIN SIZE (mm)
PARTICLE SIZE ANALYSIS ASTM D6913 / C136 / D422
#200#40 #10 1.5 1/2 3 6 3/4 #4 #20 #60 #100 3/8
U.S. SIEVE OPENING IN INCHES U.S. SIEVE NUMBERS HYDROMETER
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP221069, Deb Wockenfuss, 04/06/22
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On -Site Systems Approval
Parcel I.D. 051-232-17 Expiration Date: 2 i`rz 2o2
Legal description T1 5N R1 W Section 18 Lot 180 (Proposed Corina Subd Lot 1)
Site address 19038 Richner Rd Chugiak
Current property owner(s) HUltquist Homes
X The On-site system(s) is/are approved for 3 bedrooms
Conditional approval for bedrooms, with the following stipulations:
Comments or advisories:
By: L Original Certificate Date: 11/14/2022
This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject
system(s) is/are in substantial compliance with municipal code. The Municipality of
Anchorage, Development Services Department (DSD) issues COSAs based upon
representations provided by an independent professional engineer. The Municipality of
Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Well Flow Advisory
Absorption Field Advisory Nitrate Advisory
Tank Age Advisory Arsenic Advisory
Other
COSA Approval June 2022
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On -Site Water & Wastewater Section �
Fax. 907-343-7997
Certificate of On -Site Systems Approval Application
1. GENERAL INFORMATION
Parcel I.D. 051-232-17
Complete legal description T1 5N R1 W Section 18 Lot 180 (Proposed Corina Sub, Lot 1)
Location (site address) 19038 RiChner Road, Chugiak, AK 99567
Current property owner(s) HUItquist Homes Day phone (907) 522-3204
2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS
3. TYPE OF WATER SUPPLY: X Private Well ❑ Private Well serving 2 dwelling units
❑ Private Well serving 3+ dwelling units ❑ Community Well or Public
❑ Water Storage
4. TYPE OF WASTEWATER DISPOSAL: X Private Septic ❑ Private Septic serving 2 dwelling units
❑ Holding Tank ❑ Community Septic or Public Sewer
5. SEPTIC TANK: ❑ Steel ❑■ Plastic ❑ Concrete ❑ Fiberglass
Age < 1 - See advisory if steel older than 20 years
6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench X Wide Trench ❑ Seepage Pit
Waiver request for:
Expedited review requested: t❑
Distance:
By applying for this entitlement, this property is subject to inspection by municipal On-site staff
to verify the accuracy of the information provided.
COSA Fee $ /M . Gv Waiver Fee $
Date of Payment 111ul a;z Date of Payment
COSA # C V121 S c3 % Waiver #
COSA Application—June 2022
COSA Checklist
Legal Description: T1 5N R1 W Section 18 Lot 180 Parcel ID: 051-232-17
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _
A. WELL DATA
0 Well log is filed with Onsite (or attached)
Date drilled 5/2/22 Total depth 70 ft
Cased to 69 ft
0 Sanitary seal is functioning correctly
R Wires are properly protected
Casing height (above ground) 24 in.
Date of flow test for COSA 5/2/22
Static water level at beginning of test 38 ft.
Comments
B. TANK DATA
Measured operating fluid level in septic tank N/A
Date of pumping N/A
❑ Required maintenance completed, if AWWTS
Comments: New installation
D. ABSORPTION FIELD DATA
Which system tested (date installed) 4/8/22
0 ALL standpipes present per record drawing
Total measured depth from grade 10.2 ft (max)
Measured depth to pipe invert from grade 7.2 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
0 Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced N/A gallons N/A date
Any rejuvenation treatment (past 12 months) N/A
If yes, enter date
Comments/Deficienci
COSA Checklist June 2022
Well production at time of test 7 gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes ❑ Nc
M Coliform bacteria is Negative
Nitrate mg/L 0 Nitrate less than MRL (ND)
Arsenic ug/L Fm� Arsenic less than MRL (ND)
Collected by Wheaton Water Wells
Date 8/16/22, 11/8/22
C. LIFT STATION
LJ-ReqLJ_red maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date NEW
Results FlPass
Flui epth prior to test _
Water a ed gal
New fluid de in
Elapsed time min
Final fluid depth in
Absorption rate gp
FIELD STATUS — POST F
in
Effective depth (per record drawi
Effective depth used in
Effective depth remaining _
17
in
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100'
ME Yes if No ft ❑ Yes if No ft
Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft
Absorption Field on Lot > 100' M Yes if No ft Holding Tank > 100' ❑ Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment > 50' ❑ Yes if No ft
❑ Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑Yes if No ft ❑ Yes if No ft
❑ N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No
ft
Surface Water > 100'
❑ Yes if No ft
Tank to Property Line > 5'
❑ Yes
if No
ft
Wells on Adjacent Lots:
Field to Property Line > 10'
❑ Yes
if No
ft
Private Wells > 100'
0 Yes if No ft
Water Main > 10'
❑ Yes
if No
ft
Community Wells > 200'
❑ Yes if No ft
Water Service Line > 10'
n Yes
if No
ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Forge Engineering Phone (907) 522-7773
Engineer's Printed Name Benjamin Schiller, P.E. Date 11/2/22
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